Clinical outcome of burns in HIV positive patients in Lusaka, Zambia

Abstract

Main Objective: To investigate whether the clinical outcome of HIV positive patients with burns differs from those who do not have HIV infection.
Specific Objectives:
1. To determine whether in-hospital HIV positive patients with burns are more likely to get wound infections than HIV negative patients.
2. To determine whether in-hospital mortality is higher in HIV positive patients than in HIV negative patients with burns.
3. To correlate HIV serostatus, burn wound infection, TBSA and age with burn mortality.
4. To assess the prevalence of HIV infection among burns patients admitted to the University Teaching Hospital, Lusaka, Zambia.
Design: A prospective observational cohort, hospitalbased study was performed at the UTH, Lusaka, Zambia between November 2009 and November 2010. Patients with recent burns (less than 24 hours old) who presented to the hospital during this period were recruited into the study and the parameters studied included patient's demographics, HIV status, burn history, management and clinical outcome.
Results: A total of 452 burn patients with a median age of 10.5 years were recruited into the study. 414 of the patients (92.26%) were below the age of 5 years. The male to female ratio was 1:1.3 and389 (86.06%) of the patients were burnt with hot liquids (scalds).73 (16.15%) patients tested positive for HIV andof these 44 (60.27%) developed wound infection. Mortality occurred in 7 (9.59%) HIV positive patients. Wound infection occurred in 150 (39.58%) of the 379 HIV negative patients and 57 (89.06%) of the mortalities were HIV negative. The average CD4 percentage of the HIV positive burn patients who died was 21.23% while for those who were discharged was 17.83%. The average CD4 percentage in HIV positive patients who developed wound infection was 18.88% while the average percentage for HIV negative patients with wound infection was 17.04%. Of the 64 mortalities which occurred during the study, 55 (85.94%) of the patients had more than 15% TBSA burnt.
Conclusions: The majority of burn cases admitted to UTH are below the age of 5 years. HIV positive patients are more likely to have burn wound infections than those who do not have HIV (p = 0.001). The HIV status of a burns patient does not significantly alter the outcome of burns in terms of mortality (p = 0.221). There is no difference in the prevalence of HIV infection in burn patients and the general population.